Pharmacogenomic Summary Report
Gene-Drug Interactions by Drug Class
Use as DirectedMild or no gene-drug interaction; no PGx-based action, standard precautions apply.
Moderate Gene-Drug InteractionUse with caution; dose adjustment, slower titration or monitoring may be needed.
Significant Gene-Drug InteractionSerious interaction; avoid or select an alternative where possible.
1, 2, 3… Clinical considerationsKey below. Gene(s) listed after each flagged drug.
Current medications with significant gene-drug interactions
- Clopidogrel (Plavix) 3,4 · CYP2C19
- Codeine (Tylenol with Codeine) 3,4 · CYP2D6
6 use as directed18 moderate9 significantmedications across 12 drug classes shown
| Drug class | Use as Directed | Moderate Gene-Drug Interaction | Significant Gene-Drug Interaction |
|---|---|---|---|
| AntidepressantsSSRIs |
|
|
|
| AntidepressantsSNRIs | None | None |
|
| AntidepressantsTricyclics (TCAs) | None | None |
|
| Mental healthAntipsychotics | None |
|
|
| Mental healthADHD medications |
|
| None |
| PainOpioid analgesics | None |
|
|
| Pain / rheumatologyNSAIDs | None |
| None |
| CardiovascularAntiplatelets | None | None |
|
| CardiovascularStatins |
|
| None |
| CardiovascularAnticoagulants | None |
| None |
| CardiovascularBeta blockers | None |
| None |
| GastrointestinalProton pump inhibitors | None |
| None |
Clinical considerations (key)
- Serum concentrations may be higher than expected; increased risk of side effects.
- A lower starting dose and/or slower titration may be required.
- Reduced formation of the active compound/metabolite; efficacy may be reduced.
- Guideline recommends considering an alternative medication (indication-dependent).
- Therapeutic drug monitoring recommended to guide dose adjustments.
- Increased statin exposure and myopathy risk; follow genotype-based dose limits.
- Serum concentrations may be lower than expected; a higher starting dose may be required.
- Calculate initial dose with a validated pharmacogenetic algorithm (VKORC1, CYP2C9, CYP4F2).
- FDA labeling identifies a gene-drug interaction; refer to the label for dosing.
- Severity depends on co-medication: avoid with moderate/strong CYP3A inhibitors or strong CYP3A inducers.
- For chronic therapy (>12 weeks) with efficacy achieved, consider a 50% daily dose reduction.
Significant interactions: guideline actions
Clopidogrel · CYP2C19 intermediate metabolizer. Reduced activation expected. For ACS/PCI indications, consider prasugrel or ticagrelor at standard dose if not contraindicated (CPIC).
Codeine · CYP2D6 poor metabolizer. Little conversion to morphine; inadequate pain relief likely. Avoid codeine and tramadol; consider a non-opioid or an opioid not metabolized by CYP2D6 (CPIC).
Genotype & phenotype results
| Gene | Genotype | Phenotype / Result | Notes |
|---|---|---|---|
| CYP2D6 | *4/*4 | Poor metabolizer | Affects many antidepressants, antipsychotics, opioids and beta blockers |
| CYP2C19 | *1/*2 | Intermediate metabolizer | Clopidogrel, citalopram/escitalopram, PPIs |
| CYP2C9 | *1/*3 | Intermediate metabolizer (AS 1.0) | NSAIDs, warfarin, phenytoin, fluvastatin |
| CYP3A5 | *3/*3 | Poor metabolizer (non-expresser) | Most common genotype; standard tacrolimus dosing |
| CYP3A4 | *1/*1 | Normal metabolizer | |
| CYP2B6 | *1/*1 | Normal metabolizer | |
| SLCO1B1 | *1/*1 | Normal function | Standard statin dosing |
| TPMT | *1/*1 | Normal metabolizer | |
| VKORC1 | -1639 G/A | Increased warfarin sensitivity | Use with CYP2C9 and CYP4F2 in dosing algorithm |
| CYP4F2 | *1/*1 | Normal function |
Comments
CYP2D6 poor metabolizer with CYP2C19 and CYP2C9 intermediate function and increased VKORC1 sensitivity. Two current medications warrant a prescriber conversation: clopidogrel and codeine. Warfarin, metoprolol and celecoxib may need dose adjustment or monitoring. Sertraline and simvastatin can continue as directed from a PGx standpoint.
Source laboratory / Report IDSample Laboratory · SR-000000
Prepared bySample Pharmacist, PharmD
Date09/16/2026